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SUPERVISION IN THE COMMUNITY 'TO THE CARE OF EMPLOYMENT AS A PLACE OF PATHOLOGICAL COMPARISON between psychoanalysts and pedagogical William Champion

                                                                                        




1. The need to recover the historical origins of the therapeutic community.

The therapeutic community is a therapeutic device, or teaching in the evolution of treatment and rehabilitation of mental disorders in the second half of the twentieth century. According
E. Pedriali, an Italian scholars pay more attention to our subject, unfortunately passed away recently, the historical merits of the concept of therapeutic community were three: to have brought to the fore the value of the group and reveal the therapeutic potential, have defined a concept team as a means of fragmented understanding of the universe of the patient, he stressed that the sharing of daily life allows you to find answers to the needs of patients by mediating between inner and outer reality.
The therapeutic community has been and remains a "place" of important meetings between people but also between hermeneutic and operational models, such as that between psychoanalysis and pedagogy, psychoanalysis and medicine, psychoanalysis and psychiatry, psychoanalysis and psychology, psychoanalysis and the Arts declination rehabilitation-expression. In Italy
communities for employees have gone through a long period of experimentation led mainly by following a pattern of behavior: on one hand the second The American model (the experience of Carl Ederick founding of Synanon community for drug users in Ocean Park in California in 1958 and that of Daniel Casriel of Daytop Lodge) originated from the practice groupal of Alcoholics Anonymous, 12-step program and so on. and other second behavioral-style Catholic teaching practices more recently merged into the epistemological model of systemic family.
As I noted in other studies (G. Champion, 2007) the story of the relationship of psychoanalysis with drug addiction in some ways mirrors the history of the uneasy relationship between psychoanalysis and pedagogy and the relationship between psychoanalysis and pedagogy. The therapeutic communities for employees born almost thirty years after the founding experience of the psychoanalytic English-style end of World War II, traveled from the time of their birth, not on a parallel track, sharing with the community psychiatric history, and epistemological models. (G. Champion, 2007)
The development of a culture of Italian-psychodiagnostic assessment pichiatrico dependency on the one hand increasing incidence of cases of severe psychotic drug addiction brand but it has also spent 15 years teaching the behavioral model Communities in check, inaugurating a new and fruitful period of reflection on practice and models already in use there. This has assisted
differentiation to a historic first, the result of greater self-awareness: teaching community rehabilitation, therapeutic communities and communities for dual diagnosis.
community housing for dual diagnosis patients of the narcissistic-psychotic was, in my opinion, a historic opportunity to meet with the psychoanalytic roots of the CD.
The idea of \u200b\u200btherapeutic community was founded in fact, historically, in England at the end of World War II by a particular organization of a rethinking of traditional psychiatry department of Military Hospital in Northfield by WRBion.
The community shares, then, with psychoanalysis, and psychoanalysis in particular social group and an 'inextricable relationship is foundational, historical, theoretical and clinical groupality to open, open the "third", introduces the category of supporting the growth and differentiation.
The first historical definition of CT is in fact the analyst Tom Main, the founder of the therapeutic community of the Cassel Hospital: "An attempt to use the institution as an organization run by doctors who want to achieve the best from a technical point of view, but as a community whose immediate goal is the full participation of all its members to everyday life, while the ultimate goal is the reintegration individual in social life. " We need to
Foresti, Ferrite, Vigorelli and Pedriali the most important historical and systematic survey of the phenomenon of "therapeutic community" in Italy but who has the only major shortcoming, however, with regard to therapeutic communities for drug addiction.
According to these authors in England have distinguished themselves as important experiences that Henderson Hospital, Maxwell Jones, community for teens to Winnicott, the Tavistock Clinic, in France, the French experience of the Community Racamier La Villette, in Ville Sassolas to that of Urban and Olivenstein Marmottain the Centre of Paris. In Italy have historically been important experiences of Italian Hospital Day Boldù Palace in Venice, including Basaglia in Trieste, Fabrizio Napolitani, first in Switzerland to "Villa Landegg" and then to "Therapeutic Community" in Rome, the historical experience of Villa Serena and the Community Omega in Milan. Add to this the experience of Eugenio Gaburri hospital in Varese, experiences and Zapparoli Charmet, the experience of Marco Comelli Francesco Sarno and the hospital department of psychiatry Cinisello, Milan.
The community was the birthplace and has developed the culture of the investigation on the establishment and its social and emotional dynamics, its risks, its opportunities along the axis of individual-group-search-family società.fino the birth of the key concept of Institution Total and its analysis by the central authorities as Foucault, and F. Gofmann Basaglia: an institution whose main feature is to seize the time of its participants taking as the sole aim of its exclusive survival, away from the purpose that ab initio, it had set itself, and for which she was born
In a more modern Correale (1999) described the institution as a large field emotional when, on the one hand, are intertwined fantasies, desires, fears, and defensive systems against anxiety and fragmentation, suspicion, attacks, and, secondly, it seeks to confirm and perpetuate itself through self-reference el ' autoconferma.
The community was also the "place" where he developed the clinical psychoanalytic culture on the family, historically, even before Margaret Mead and Gregory Bateson process-relational ecological principles on which the school will come systemic.
The community has finally elected a place of reflection on living and sharing the space in terms of suffering according to coordinates psychoanalytically based (external reality and inner reality, inner world and outer world, inner space and outer space).
E 'then a' chance meeting between Cultures of treatment (psychoanalysis among them) and cultures of the area (the 'architecture of these).

2. The pedagogical model of the traditional Catholic community and the innovative contributions of the psychoanalytic model.

pedagogy, despite a century has passed from the first, Freud's revolutionary discoveries on the functioning of the psyche, remains largely irrespective of the acquisition introduced by the use of psychoanalysis and cognitive models in which the relationship between emotion and thought is completely ignored and there still a hypothesis that takes into account the overall significance of the presence of the unconscious in all its many forms of expression. Key concepts related to the necessary distinction between feelings, emotions and thoughts, or the conflict inherent in the mind-body relationship, or the way in which the mind is free of the frustrations, evacuation or denying it, should be part of the cultural background of each teacher as well as an attitude of listening to "all" the emotional content, entirely non-judgmental moralistic should help patients to have care and respect for their own and others' thoughts. The goal, of course, is not to subvert the rules of the various functions as a therapist and educator. Rather there is a strong belief that a better understanding of psychic reality could allow it to best fulfill its tasks without encroaching on the other in different fields and inadequate to its jurisdiction and the context in which it operates just like a teacher physical education can benefit from a thorough knowledge of the human body, without feeling either in law or in the duty of a doctor. (Ginzburg, 1996)
The psychoanalytic culture as we know, is quite common in centers that deal with mental health, but not always with sufficient clarity of duties, limits, methods, conditions of the setting. This is especially true, in my opinion, in the case of educational and rehabilitation centers, especially a religious setting, where often psychoanalytic culture struggling to assert itself. On the other hand, it is known that the Catholic doctrine precludes the existence of an unconscious dimension and mythical favoring the primacy of the intellect, will and morality. (Drewerman E., Psychoanalysis and moral theology, depth psychology and Exegesis). In a recent essay
Ancona (2006), a Catholic psychiatrist and psychoanalyst in one of his latest works entitled "The church's debt to psychoanalysis" (2006) recounted the complex history of relations between the Catholic Church and psychoanalysis: "In the beginning, and this was war waged without saving shots, from both parties spoke of death, an event that everyone hoped for the other. Then gradually, due to the absence of fundamental respect, the differing positions began to dull. Christian anthropology and religious were certainly inconsistent, but took over a certain distance between them, a mutual ignorance and was eventually the appreciation of individual aspects of the enemy camp, so we started an exchange between psychoanalysts and believers, leading to a meeting today went a long way. The thought of Matte Blanco, in particular, has in fact tried to reconcile the apparently irreconcilable as well as group-Foulkes allowed to see the analytical anthropology overlap with that of his Church. At the point of today make possible the recognition that the institutional Church regardless of the merits of his mystical reality, owes much to Psychoanalysis: is the debtor. "
The spread of psychoanalytic culture by universities and graduate schools in psychotherapy has recently allowed its spread, beyond the more or less rigid ideological approach of rehabilitative institutions, through professional psychologist and a psychiatrist's time is very rare.
The critical point was fundamental to the process - as has been said that the so-called dual-diagnosis (severe psychiatric drug addiction) gradually spread awareness of the nature of the psychopathology of addictive behaviors, and this has also convinced the authorities care to pedagogical more reluctant to adopt psychologists and psychiatrists. It happened then that psychoanalytic interventions could also fertilize and enrich the culture of these institutions, although not openly and systematically, but, as often happens-"closed" meetings of the team. This process has positively
laid the groundwork for a resumption of comparison with the historical-scientific foundations of therapeutic communities, born during World War II as part of psychoanalytic psychiatry in England by Bion, Foulkes, Main and Jones. The
address the relationship with the addict patient with associated psychopathology necessarily entailed a shift from the traditional pedagogical approach-behavior, that perhaps he had also worked with drug-addicts with neurotic, to a setting of clinical- medical and psychological fields best suited to new drugs, more and more borderline pathological narcissism, antisocial, paranoid, always with most frequent disorders of the self. This step could not, in my opinion that the future integration of diagnostic knowledge and processes with a view complementary individual-family, and with an attitude of openness to the comparison of scientific knowledge.

3. The psychoanalytic setting critical super-ego of the educational community.

One of the criticisms of psychoanalysis of the superego at the traditional therapeutic community was-and still is - in fact this: if the disorder is, at deep levels of being, in a narcissistic withdrawal from relationships, focus on the super-ego does not make sense. Setting superga can lead to a pseudo-identification, to an outcome in terms of conformity, in terms dell'iperadattamento rather than a true personal care, or, as they say, a real individualized treatment. From the point of view of psychoanalysis the core of the disorder, as we have seen, is a deadly narcissism, resulting in a lack of concern for the moral value of something else. The inability of many of these patients to conceive of the Other, to have a loving relationship with each other, and locking in a self-sufficient enjoyment in which the other is no longer controllable so powerful, certainly not can only be addressed by censoring and scolding. This seems an important point of encounter between psychoanalysis and pedagogy. How
said Mitchell (1995) "It is believed that today many patients suffer not a childhood passion convertible conflicting with reason and understanding, but also a personal development stunted. The modern psychopathology can now be defined not in terms of conflict, but the patient's experience of poverty. Often the patient's problem is to be able to reinvest the affection and meaning something else, leaving the state in which remains fearful of refuge. The patient needs a revitalization and expansion of the capacity to generate experience real, meaningful and valid (...). What he needs is to be seen, personally involved and basically appreciated and cared for the opportunity to playfully explore and discover their own subjectivity and imagination. "

4. Current status: the cure for all ills intervention on selected subjects in some stages of treatment.

For years, the therapeutic community life and was proposed as a "total strategy" a panacea against all evils, good for all seasons.
Today we start to reflect on the need to transit from one organization to an ideological ' organization providing clinical treatment as a process divided into several phases to be tackled with different techniques and preparatory (G. Champion, 2009). According to Henry
Pedriali the therapeutic community, currently has two possibilities: either the culture fail to express a flexibility that enables it to address diverse needs (and then need to abandon the claim allegiance to a mistaken orthodoxy), or otherwise will have to give to present itself as a method suitable for a large proportion of disease (particularly severe psychotic disorder): in any case you will have to abandon the illusion of a Community setting feasible for all types of users
After decades of experimentation and improvisation in the current situation has reached a sufficient theoretical and clinical knowledge of the EU system in order to define predictors of its effectiveness or ineffectiveness of therapy: second Correale they are linked to the ability to mourn the separation from family before entering and the subjective degree of stability or fragmentation of the self and the therapeutic factors are to be found in the sharing of everyday life, the network of relationships, in the sense of belonging and the possibility of activation of scenes and emotions psychically significant.
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5. The supervision of the staff of the Community as a place for discussion of psychoanalysis and pedagogy.

I state here are some reflections on my experience as a supervisor of the team of a historic community for therapeutic Milanese, founded about 30 years ago by Cardinal Martini: the community Alisei Ambrosiano Solidarity Centre (CEAS) in Milan.
Supervision is one of the "places" of thought where it is possible the attendance of the psychoanalytic culture even in clinical psychoanalysis as the therapeutic community.
In these services, often, in my experience, operators may find that they lead a job with a high emotional impact, not being able to have tools to be able to develop and understand enough. On the other hand, the pedagogical model-in this not unlike the traditional doctor-who depends on the primacy of intellect and as sources of ethics will exclude affective unconscious motivation of behavior. These professions have, therefore, share the report with the other - inevitably affettivizzata, in negative or positive-working as an object, they share in a very similar repair-depressive unconscious motivations in the choice of profession but paradoxically, at least in part, unaware of everything.
Supervision allows not only to explore the emotional state of the team, as we will see the organization as well as clinical, ethical and professional status, the treatment plan, the connections between the particular and the state of daily general mission of the institution and settlement of the structure. From this point of view represents a fundamental tool for a group, even unconsciously, constantly attracted towards the organization and primitive of the basic assumptions of dependency, pairing and fight-flight (Bion), may be still a working constantly checking its stated goals and its organization to do so.
add that it is an important opportunity for executive directors to acquire instruments to distinguish between not wanting, not understanding and not being able to tout-court-to do their job as an educator and emotional difficulties, cognitive Typical of this role.
Some operators sharing in teams is a source of suffering: the group, in fact, can amplify the emotional fears, exposes the face to face, exposes her to an intimacy to those who need to flee, may reverse at developmental stages that were thought exceeded, often raises questions of overlap and conflict between the professional fields that make the strings resonate more than others, and to ancient and topics ranging from envy and cooperation. Undoubtedly, the current historical and cultural moment seems to favor this kind of mental organization and more oriented to the defense in the division, the experiential awareness of the horizon broader than the work of mentalization promises.
For operators and supervising the group may well also represent opportunities for loss of power, or rather the loss of fantasies of power inherent in a profession, but also personal and professional growth. Admit that we are not as mono dimensional, integer, we do not have any power over us and the patients can definitely upset. Admitting that there is an unconscious dimension (Ours, the patient and that of colleagues) with whom we report, willy-nilly, and that we can influence, is a wound that not everyone can tolerate. The training also made possible thanks to supervise effectively calls into question the self-image, shape and definition of self, identification, and it is essential to tolerate uncertain times in which you navigate with the feeling of having lost the plot.
The supervision group is a job that allows you to connect, compile, share, hybridize and integrate what is split and separated into the dominant culture in the individual mind even before the operators in the minds of patients. It may constitute a reason, then, as one of the possible places - beyond its specific subject-clinical work and construction of shared thinking - just as such - the answer to the inconvenience of living contemporary
addition, the group operators to work in supervision is a perfect size for combining the individual element with the element of collective and therefore raises the border between object and subject of education training. The supervision in the institution is, in fact, an essential tool for personal and professional resources rimobilitare blocked due to heavy patient's projective identifications that could not be found Another possibility of containment and processing. In supervision, therefore, seem to live a training function and a therapeutic function when it becomes necessary to take care of even the affected operators.
From this perspective, supervision is considered to be time critical to ensure quality clinical intervention as well as welfare because it allows operators to structure over time, so constant, a number of occasions to give a conceivability to certain emotions with no name, to stay the proceedings, to observe the interaction intellectual, physical and emotional with the patient and to suspend the need for action and decide immediately.
What emerges clearly from the consistent supervision and that the handling is a core function of the EU system capable of representing an overview of the mental world of fragmentation, contain it and to make sense. The multi-professional composition allows to take charge of different parts of the patients by giving them the dignity of life (even before democracy of affects internal and external). Patients living in fact different parts of himself with various providers (especially with so-called case managers) and is therefore essential to communicate these aspects split into a space as the supervision to reconstruct this kaleidoscope. From these operations, the connection between their emotions, the emotions of colleagues, patients and those assumed as the supervisor may arise, like a puzzle, a mosaic variegated and rich, complex identities of patients, the parties to their conscience scotomize that come in the form of raw emotions in the minds of operators and, as such, are digested, recognized and symbolized (gamma function).
There are two conditions that represent a real risk of transition from therapeutic function of care consistent with that of the "bureaucratic" rules of ensuring Community: on one hand the tendency for operators to strive for a system of intervention less rich, but simpler and less demanding when the boundaries between the individual skills are safer, less rigid and go beyond that and are the preferred options and organizational practices. Across the 'instability thymus and relational aggression and transgression of the rules el' orientation to get everything right away patients.
operators are often so busy trying to mediate between these two opposing positions are difficult to reconcile rationally.

6. operators in symbolic balance between family and natural family.

Despite the operator community is then - as always-Charmet brink of a nervous breakdown, parodying the title of a famous film by Almodovar, in my opinion the community is a social laboratory within which we can understand more than any other place .
From this point of view I agree with Charmet when he says that the therapeutic community is not a cure, but offers unsurpassed in terms of being able to understand.
I think the ability to understand and be understood better from elsewhere depends on your sleeping, eating, decide together the best conditions in order to rebuild its internal divisions and the patient's projections. Contrary to what in fact occurs in the care-as it were outside-where the patient puts in several parts if it interacts with professional (doctor, psychiatrist, psychotherapist, counselor, educator, social worker, nurse, mediator) and social (family, employers, etc.) in common defensive affective these movements occur not only on team unity, but also an anthropological space and logistics community and is the setting that allows to reconstruct like a puzzle in the self-mind of the team-the true self of the patient.
It therefore represents a rare opportunity for the analyst to work in the life actual patient observation and evaluation aspects newspapers (actions speaking, Racamier), emotional-affective aspects of his co-inhabit in relation to others (a "resident emotional," a home for their emotions, where second-Zapparoli - aspects of attachment and caregiving can be seen and cared for through the indirect approach, mediated, the transitional "situations as if" G. Champion, 2009).
Not only that, but in this condition can understand it also coincides with the ability to be better understood: that is to make available to the patient and his group, the true self of the team community, which lives up to the background experience of community. From this point of view this is a team that has a natural tendency to collapse on the functions of the natural family of their own user and not quite get the family to remain symbolic, the family culture. Hence the indispensability of a Psychoanalytic supervision. Because the therapeutic community, when the family is about to become the everyday and to share with the patient, avoiding to become to the extent that the size of the report opens with a unique dimension: namely groupality. Open the third to the extent that any practice of the Community institution become type group. It 's the third reference to the antidote against collapse of the possibility of identification with the family.
So the Therapeutic Community is an institution that thinks in terms of projects of social birth, even if it is true that the actual practice is to performing a reinfoetation mother (Charmet) to take in, but his great hope is to to revive. It does not take in to lust, does not take into on behalf of the resignation, but the possibility of reorganizing the hope of a rebirth, it is seen in the name of someone who, in the name of such values. It seems to me that we can say that the evolutionary aspects of the therapeutic community, the ones who deserve the most serviceable part of the supervisor, are those related to the fact that the therapeutic community is the home where you make an objective of reinfoetation (Charmet)-but-important difference is on a birth and relies on the group of brothers, but brothers working under the auspices of the paternal symbolic function, so from this point of view it seems to me that rebirth can take place at 'shade of the values \u200b\u200bof his father and then as a function of social birth. From this point of view of the therapeutic community can not really become the incestuous family, the father and that of the standard. "(Charmet)
in therapeutic communities-in fact, many patients who come from an experience with a" single parent " (Actually a prevaricating on the other parent is usually absent, abandoned, dependent) may perform rather close relations with both the protective aspects, accuditivi (fusional-symbiotic, female and maternal) with aspects that male paternal symbolic Law and real (the rules, the limit, the boundary, differentiation, separation, detection)) (G. Champion, 2009).
This can happen where there's work to be aware of these issues and therefore from the pedagogical point of view share a hermeneutic epistemological model that agrees to deal with the psychoanalytic.
For my seven-year experience, CT Winds of CEAS in Milan is one of these places.


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